Topics Related to Medicaid Managed Care

Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation

Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.

Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.

Withdrawal Management Policies Delayed

The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.

Recent State Plan Amendment outlines duties of a responsible third party

Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.

The Centers for Medicare & Medicaid Services has approved State Plan Amendments to revise reimbursement methodology.

Includes information on Provider Fact Sheets, LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks and more.